Childhood abuse and depressive vulnerability in clients with gender dysphoria

Abstract

Background: The recent reclassification of gender identity disorder as gender dysphoria (GD) in DSM-5 identifies those seeking to pursue gender transition via specialist services as necessarily 'distressed' and therefore mentally disordered. Distress in gender variant clients may arise from a variety of stressors, external and intra-psychic, many of which may have their roots in childhood experience [E. Bandini et al. (2011)]. Aims: (1) to review current thinking on gender variance and recognition and classification of GD (2) to detail the contribution of childhood adversity to distress in gender variant clients from an audit of 50 such clients (33 assigned/natal males and 17 assigned/natal females) of a mainstream NHS psychosexual service. Methods: Current issues in classification and diagnosis of GD, and debate on the aetiology of gender variance, are reviewed briefly. Audit findings on health, treatment issues and support, and thematic analysis of childhood experiences, provide the basis for a case example of a post-transition client experiencing some common difficulties associated with GD and childhood adversity. Conclusions: Pragmatism of diagnosis and treatment of GD contrasts with the variety of theories of causation of gender variance itself. 'Distress' as a precondition of treatment may reflect childhood experience as much as GD-specific symptoms, and may contribute more to persistent psychological vulnerability. While educational programmes in schools and a better knowledge base in counselling and related training curricula are indicated, gender dysphoric clients, pre-and post-transition, experience common life problems for which generic forms of counselling and therapy are appropriate.

Operational Definitions and Structured Instruments for Childhood Emotional Abuse in Clinical Research: A Narrative Review

“…In certain cultures, children with same-sex orientation or those who are struggling with gender identity issues are at risk of being psychologically maltreated. 31 EA in the context of academics also varies across different cultures. While educational neglect is a well-documented form of childhood neglect, the opposite is common in some cultures.…”

“…In certain cultures, children with same-sex orientation or those who are struggling with gender identity issues are at risk of being psychologically maltreated. 31…”

Childhood abuse, depressive vulnerability and gender dysphoria: Part 2

“…With increasing numbers of young people and adults in the UK seeking gender reassignment treatment (GRT) (Reed, Rhodes, Schofield, & Wylie, ; Royal College of Psychiatrists, ) and responsibility for the commissioning of specialist gender services having transferred to NHS England in April 2013, this is a critical time for gender variant clients who require psychological and/or medical services. An earlier article (Firth, ) used a review of the literature on childhood abuse and neglect and lifetime depression in clients with gender dysphoria (GD) to underpin two case examples to illustrate key issues for therapeutic practice and service provision. This article differs by focusing on the recent reclassification of GD and by providing a summary of aetiology from three distinct perspectives.…”

“…The scant literature on childhood experiences of gender variant people does not appear to support childhood abuse or neglect as causative in the development of GD, rather the former appear to exist alongside GD (see summary review in previous article; Firth, ). Here, the focus is on current issues in classification and diagnosis, including the contested nature of the aetiology of gender variance, and on the potential for childhood adversity to perpetuate ‘distress’ in adult GD clients.…”

Uma abordagem longitudinal da contribuição do trauma e da vergonha nos sintomas depressivos em adolescentes

“…Os indivíduos com história de abuso sexual na infância relatam uma história de vida de depressão em cerca de 30-40% (Mandelli, Petrelli, & Serretti, 2015;Musliner & Singer, 2014). Outros tipos de traumas ocorridos ao longo da infância e adolescência (e.g., abuso emocional, negligência física, emocional) têm mostrado poder operar como fatores de risco para uma variedade de perturbações mentais que persistem na idade adulta (Firth, 2014;Liu, Alloy, Abramson, Iacoviello, & Whitehouse, 2009;Mandelli et al, 2015). Crianças com história de abandono/negligência estão em risco de aumento de sintomas depressivos na idade adulta (Hopwood, Ansell, Fehon, & Grilo, 2011;Kim & Cicchetti, 2006;Pinquart & Shen, 2011).…”